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PLUMBING-INSPECTOR RECORD <br />APPROVALS DATE tD/stG.COMMENTS <br />UNDER GROUND <br />Waste & Vent <br />Water-Under floor <br />Buildinq Sewer <br />Area/Storm Drain <br />ln terceptor/ Clarifier <br />TOP OUT <br />Waste & Vent <br />Water Piping <br />Gas Pipinq <br />Roof Drain <br />Tub/Shower Test <br />Rouoh Water Heater <br />POOL/SPA <br />P-trap/Drain Line <br />Main Drain/Pool Piping <br />Fill Line/Back Flow <br />Pool Heater/Gas Line <br />Miscellaneous <br />Gas Service <br />Water Service <br />Lawn Sprinkler <br />Sanitary Sewer/Cap <br />Back Flow Device <br />Rough Plumbing 1->J-l r I}.v/)t) <br />Meter Release -A <br />FINAL I Y*hl <br />Notes, Remarks, Etc.v <br />OWNER BUILDER DELCARATION <br />I h.Eby .frm undcr Fndry 6t pcrjury fi,l I m cxcdpr ios rh. Conmcto^' Ltens LiD for rh. followa.g Ea$n (5(.7011.5 <br />Busincss !,n PrDfcssion Codc): Any Cily or Coudy which rcqdrcs a p.mil to coneNct. rld. imlrovc. dcmlsn or Epat dy <br />srocle, fior to irs issure. als rcqliEs thc apllicMl for scfi p.mn Io filc . siBrcd sllrcmnr thar l* or shc n Uansd I,urtudr <br />lo ttr pDljsioff of llE Contrctols Lie.sd rnv (Ch,pr( 9. Commai.S snh &.tion 7000 of Divisi.n I of lh. Busin$s ud <br />Prcfcsions Cod.)or rlid h.s d! h.rcm rh.rciiom$d rlE tEsis for rnc.lL8cd cktrlPrhn. Any vbhrin oa Sanbn 7011.5 bt 8ry <br />anplicani lo, a Fmi $bjds rhc appli.! loacivilp.mlr,oanor mrc rhu fivc hundr.d dou&s (5500), <br />-1. <br />6 owrcr of lhe FoFny. d ny.trploy..s wirt vleca &r rlrct $h moFMiotr wil do tlE w* s,n d* $urR b mr <br />i c,'d{d or otreEd fd $lc (Se.?044, BNiftn .nd kofcasions Cod.: Th. Conrrdm s LiccN L.* .lo.s mr .ppl, ro !n ond of <br />llE potfiy slb hilds or in{r.ks lh.6[ aid s]b dd3 kh w,t hihsclf or h.rklf or lhmugh his 6r lf,r own cmploy..s, <br />oaidcrl rhlr iuch imp,oEftiis G mt i'{.idcd qofrcrn for slc.lt,Dtu6. rhc h,iuing or i'rircrmnl b sld wnhhor t@ <br />ofoqrlciiotr tlE OwF Buildn win hrw tlE hlno of Fvir8 t,l lE or dr dn d huiu or itr+iorc lhc pDpsl, for lhc porpos of <br />-1. <br />!so*trcrnlthcpop.ny- ir.ciclu\ivclyconrrcring virh li..n$d c.Nacntrs to c.nsrrucl rh( ooj0cr (SLr 7(144. Bu.inc\r <br />afrl Pioli:$i.nCod.r Th.Conttrctr\ Licctrsc l-awdoc\ noi nFlykJMo*icrofprolPrtywhohuildsorirnr.vcslhcrcotr. <br />and qho co rlcls Inr nEh fiqccr s qirh r Conrrrcx"( s ) licc.scd purunr ro rh. Conrructols l,iccn* Lr* ) <br />-l <br />umcicnrpl undcr Sc.l 8.&PC forlhisrcoson. <br />llaxffB!:toMtExsAllo! <br />D[CUAA.u0! <br />I hcrhy rffirm undcr p.naliyolpcrpry.i..frhc lhlb*in8 dcclorions: <br />-l <br />haE dd *ill minrain ! Ccnificlrc of Conrcnt to Scla l.suE for vortds omp€fletion. s povi&d for by Srcrhn :1700 of thc <br />tjbor Cod., aor llE pdfomrc. of lhc MrI fo, vhhh lhc lldml ii i$.d, <br />_l n v. .ld will mintlin wort r' com!.nsdion insuEtrcc. !s rcquiEd by Sction llo0 of <br />'h. <br />trbor C.dc. for tlE Frf()lmtrc of <br />lhe work ftr whicn lnis Fmi ir t$d. My *orkctr smpcrelion insurare ceic rd Flty numbcr e: <br />Poli.yNumhci Expncs: <br />-lcenityth <br />inth.I,€rtormarccoflne,o for *hich rhh pcrmil is issuct.l shollnorcmtloya.rrcson inonyddncr <br />$ asb b.coft subj.cr ro rh. worlcs .onFn$rnrn hws oacaliforoiu, Md a!rcc lnnr iiI should bccom subl..' io lnc <br />*0116' sn ..salion pn,visions of S.ori.n l70O ol rhc btb, Cdlc. I rhdl. fonhwili smply wiih rho* <br />WARNIN(;: F ilrc l. \c.trrc workcrr conDcnw(covcma. is onhwtul. lnd shall slhie.r d cmnloltr ro oiminal <br />ilion to rhc cosr oi cod!.ns ion. domacs !s prov <br />I h.Bby alirm u.dcr D.n0lry of Frjury lh0l tdcr pmvkio.ofClDprs 9(conmncin8 wirh Sstion ?000) ofDivhion l <br />of rhc Buiincsi d Pr.r.sion\ Code. ard fty liccnrs h in tull ihN a.d cfrccr <br />Vt <br />I lcEby dlm u.ds Fn lry of r.du.y thir <br />ilsed (Se. 3097. Cie. C. ). <br />rudhn Lndins aCctry for rh. pc.fonBec ol rh. work lor Rhich lhir Frmil ii <br />AIELICANI.DEII,I IBAtrON <br />I hcEt y .trm undcr penally of poJury orc ol $c followins dcclanrionsl <br />Dcmlir ion Pcrnirs-Asbcslos Nolif,c ion F.dcBl R.Suhrions (Tillc /o. Prn6) <br />-R.qlircd <br />krld of Nolifroriotr <br />I ccn,ryrhd rhd l.dcnl.c8r!,ri,rtr\ 4gu&li0! J\h({o\i(irBnrlrrc 0orrpnliclhld h rhi\pDjc.r <br />Gas-Underfloor <br />Final Gas Test Lf,ndcr'\ Addr$ <br />I h{w rcsd rhis lpplica'ion md rurcrhlr rhcfirvc <br />*6:ELg <br />Mlh*?l# <br />-------r----- <br />I <br />I <br />=